Hope this helps
|
ROLE
OF THE PEDIATRICIAN IN PEDIATRIC TRAUMA CARE |
|
|
Hershey Medical
Center ? Hospital Administrative
Manual |
Policy
Number: PC-38 HAM |
|
Replaces:
New |
Effective: June,
2002 |
|
Authorized:
Steven D. Baron
Executive Director & Chief Operating
Officer |
|
Approved:
A.Craig Hillemeier, MD
Chair, Department of Pediatrics,
Medical Director, Penn
State Children?s Hospital |
|
Approved:
Robert E. Cilley, MD
Chief, Division of Pediatric Surgery
Pediatric Trauma Program
Medical Director |
PURPOSE
The ultimate responsibility for
the pediatric trauma patient lies with the attending surgeon to whom the child
is admitted. This will under most
circumstances be the pediatric surgeon on call when the child is admitted or, in
the case of certain isolated head injury patients, the neurosurgeon on call for
neurosurgery at the time of the injury.
The injured child will be admitted to one of the in-patient units of the
Penn State Children?s Hospital at the Milton S. Hershey Medical Center.
The Department of Pediatrics has
an approved residency training program in general pediatrics and includes
specialists in all of the major disciplines of pediatrics. Pediatricians and pediatric residents
become involved in the care of injured children under a number of circumstances
as described below.
POLICY
The role of the pediatrician in pediatric
trauma resuscitation: The
trauma team leader, under the supervision of the attending pediatric surgeon,
directs the activities in the pediatric trauma resuscitation room. The Pediatric Critical Care Medicine
attending and a pediatric resident on call in the PICU are included in the
pediatric trauma response. The PCCM
service provides consultative care as requested during resuscitation. This may include but is not limited to
assistance with the institution of mechanical ventilation and the choice of
ventilator settings as well as the initiation of care for intracranial
pressure. Under circumstances such
as a ?trauma code? which requires simultaneous medical and surgical
resuscitation, the PCCM service will supervise the administration of
resuscitative medications while the trauma team attends to issues such as
airway, intravascular access, and the treatment of life-threatening injuries.
The pediatric resident assigned to the PICU is ATLS certified and may provide
assistance in the resuscitation as requested by the Trauma Team Leader.
The role of the pediatrician in the
Pediatric Intensive Care Unit:
Multiply injured patients are admitted to the Pediatric Surgery Service
with concurrent care provided by the Pediatric Critical Care Medicine Service.
Concurrent care includes the use of mechanical ventilation, sedation and
paralysis, the management of intracranial pressure, and the immediate oversight
of all aspects of patient care in the PICU. Invasive procedures may include jugular
venous pressure monitoring for ICP and CPP management. Immediate life-saving
procedures required for airway management and the treatment of hypotension or
pneumothorax may likewise be performed. A pediatric resident at the PGY-II level
or above is in attendance and immediately available in the Pediatric Intensive
Care Unit 24 hours a day as the first-responder for life-threatening emergencies
and works under the supervision of the Pediatric Critical Care Medicine
Service. The residents are ATLS and
PALS certified. Concurrent care
provided by the Pediatric Critical Care Medicine Service involves the
minute-to-minute oversight of all activities within the Pediatric Intensive Care
Unit. Cooperative relationships have been established that provide the optimal
care for the injured child under the direction of the attending surgeon. Communication between the Pediatric
Trauma Service and the PCCM service occurs formally and informally throughout
the day. The on-call PCCM resident
accompanies the Pediatric Surgery Service on morning rounds; the Attending
Physicians review the plan of care daily, and residents on each service review
the plan of care.
There are instances when a child
is admitted to the General Pediatrics Service and as the history and evaluation
proceeds a suspicion of abuse becomes evident. The hospital policy, ?Trauma/Non-Surgical Admissions of
Pediatric Patients with Suspected Child Abuse? is followed when a diagnosis
of child abuse is entertained.
The role of the pediatrician as a
consultant for the pediatric trauma patient: Because the pediatric trauma patient is
admitted to the Children?s Hospital, the expertise of the full range of the
pediatric specialists is immediately available. Children with concurrent lung disease
may benefit from consultative services with a pediatric pulmonologist. Children with intrathoracic injuries
benefit from the availability of our pediatric cardiologists? evaluation
including the use of echocardiography.
Some children with head injuries benefit from the early input of the
pediatric neurologists.
The role of the pediatrician in
rehabilitative care of the pediatric patient: Pediatric rehabilitation specialists at
the University Hospital Rehabilitation Center supervise the rehabilitative care
of injured children during their in-patient stay at the acute care facility.
PERSON RESPONSIBLE FOR REVIEW OF
POLICY
Pediatric
Trauma Program Medical Director
Reviewed: 6/02
Revised:
6/02
|
Hospital Administrative
Manual |
Policy Number: PC-38
HAM |
|
Role Of
Pediatrician In Pediatric Trauma Care |
Effective: June,
2002 |
Susan E. Rzucidlo, MSN,
RN
Pediatric Trauma Program Manager, CNS
Coordinator, Dauphin County SAFE
KIDS
Penn State Children's Hospital
Milton S. Hershey Medical Center
Penn State Shock Trauma Center
500
University Drive, Mail Code H075, Hershey, PA 17033
Phone 717-531-7161
FAX 717-531-3784
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